Petrovic I, Davila S, Premuzic I, Zdunić N, Trotic R, Prutki M
Clinical Hospital Center "Rebro", Surgical Clinic, Department of Traumatology and Bone and Joint Surgery, Kispatićeva 12, 10 000 Zagreb, Croatia.
J Surg Res. 2004 Oct;121(2):222-7. doi: 10.1016/j.jss.2004.04.007.
Clavicular pseudoarthrosis is a rare condition, the management of which should not be underestimated because it requires re-operations and causes serious morbidity or even a lifelong handicap.
We reviewed a series of 13 patients with non-union of a clavicular fracture who underwent a surgical treatment from the year 1993 to 2002. Twelve fractures were a result of trauma and one was a result of osteomyelitis. Twelve non-unions were located in the middle third of the clavicle, while only one was in the lateral third. Seven non-unions were atrophic and six were hypertrophic. The average age of patients was 33 years (range: 14-52 years). Average post-operative follow-up time was 4.7 years (range: 1-11 years). In the study, we used intramedullar osteosynthesis such as Kirschner wire, different kinds of plates and screws, followed by autogeneous or heterogeneous bone grafting. Constant scoring system was used to evaluate mobility and strength of the upper extremity.
A single operation was adequate in seven cases; two operations were adequate in four cases and three operations were adequate in one case. Fractures healed properly in 11 cases, but in some cases mild-to-moderate symptoms still persisted post-operatively. The results of 13 patients who underwent various surgical procedures show that a reconstruction plate should be the first choice of osteosynthesis, followed by a dynamic-compression plate, and a semitubular plate should be the last choice. To conclude, with this kind of treatment of clavicular pseudoarthrosis, we achieved a high degree of patient satisfaction, as well as objective improvements in status reports.
锁骨假关节是一种罕见病症，其治疗不容小觑，因为它需要再次手术，且会导致严重的发病情况甚至终身残疾。
我们回顾了1993年至2002年间接受手术治疗的13例锁骨骨折不愈合患者。12例骨折由外伤引起，1例由骨髓炎引起。12例不愈合位于锁骨中1/3，仅1例位于外侧1/3。7例不愈合为萎缩性，6例为肥大性。患者平均年龄33岁（范围：14 - 52岁）。平均术后随访时间为4.7年（范围：1 - 11年）。在该研究中，我们采用了髓内固定，如克氏针、不同类型的钢板和螺钉，随后进行自体或异体骨移植。采用Constant评分系统评估上肢的活动度和力量。
7例患者单次手术即可，4例患者需两次手术，1例患者需三次手术。11例骨折愈合良好，但部分病例术后仍有轻度至中度症状持续存在。13例接受各种手术治疗的患者结果显示，重建钢板应作为骨固定的首选，其次是动力加压钢板，半管状钢板应作为最后选择。总之，通过这种治疗锁骨假关节的方法，我们获得了较高的患者满意度，以及客观的状态报告改善。
